Evaluation of left atrial mechanics and p-wave dispersion as markers of left atrial cardiopathy in patients of embolic stroke of undetermined source (ESUS)

Abstract Introduction Around 25% of all ischaemic strokes have no known cause despite standard investigations. Most of these cases are suspected to have an embolic source for ischaemia, leading to the moniker of Embolic Stroke of Undetermined Source (ESUS). Recent studies suggest that abnormalities of the left atrium, in the form of atrial cardiopathy, can lead to increased risk of stroke even in the absence of atrial fibrillation (AF), which may be either as precursors to AF or as independent risk factors for the development of left atrial thrombus and subsequent stroke. Purpose The aim of this study was to measure LA electromechanical dissociation, LA volumes and P-wave dispersion as markers of atrial cardiopathy in patients with ESUS to determine whether atrial cardiopathy may be in the causal pathway of ESUS. Methods 28 patients presenting with ischaemic stroke and fulfilling the criteria for ESUS were enrolled into this cross-sectional, observational study. All patients had 24-hour Holter monitoring done to rule out the presence of AF. The control group consisted of 28 age- and gender-matched apparently healthy individuals. On ECG, P-wave Dispersion (PWD) was calculated by subtracting minimum P-wave duration from maximum P-wave duration. On echocardiography, time intervals from the beginning of P-wave to beginning of A' wave from the lateral mitral annulus in tissue doppler imaging was measured as the atrial electromechanical delay. LA volumes were recorded using the Modified Biplane Simpson's method. Statistical analysis was performed using student's t-test, chi-square test, and Pearson's test. Results Baseline demographic and laboratory characteristics were similar between the two groups. Increased PWD (34.14±9.89 ms vs. 27.32±8.95 ms; p=0.01), atrial electromechanical delay (73.32±16.31 ms vs. 63.63±13.59 ms; p=0.02) and LA volumes were observed in patients with ESUS as compared to controls. A significant correlation was also found between these parameters (p<0.01). Discussion According to the results of our study, PWD, atrial electromechanical delay and LA volumes may be novel predictors for ESUS. Atrial cardiopathy is a unique mechanism of thrombo-embolism in ESUS patients and our data establishes its association with ESUS. Further studies will be needed to shed more light on its role in the causality of stroke in the ESUS population. Measurement of electromechanical delay Funding Acknowledgement Type of funding source: None

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P-Wave Duration and Dispersion in Patients with Mitral Stenosis

10.21203/rs.3.rs-200176/v1 ◽

2021 ◽

Author(s):

Wenxia Fu ◽

Jiawei Le ◽

Xijin Wei ◽

lixiu chen ◽

Wenzhao Li ◽

...

Keyword(s):

Mitral Stenosis ◽

Test Group ◽

Wave Dispersion ◽

Left Ventricular ◽

P Wave ◽

Control Group ◽

P Wave Dispersion ◽

Wave Duration ◽

P Wave Duration ◽

Increased Risk

Abstract Background: Mitral stenosis (MS) is related to prolonged inter- and intra-atrial electromechanical delays and increased P-wave dispersion. The objective of the current study was to investigate the correlation between the P-wave duration, P-wave dispersion (PWD), mitral stenosis (MS) and to explore the cut-off values for predicting the MS in the patients.Methods: We enrolled 62 patients with MS and sinus rhythm as test group, and 62 healthy subjects matched in age- and sex- were selected as control group. We conducted the 12-lead electrocardiogram and echocardiography for all the subjects. The maximum and the minimum P-wave duration and PWD were calculated. Univariate and multivariate logistic regression analyses were performed to demonstrate the correlation between P-wave duration and PWD and MS. The receiver operating characteristic (ROC) curve was drawn to detect the threshold of P-wave duration and PWD for predicting the MS.Results: There were significant differences in the left atrial diameter (45.00±5.78 vs. 32.31±4.24 cm2), pulmonary artery pressure (46.68±17.29 vs. 32.64±2.86 mm Hg), left ventricular end-diastolic diameter (47.57±4.80 vs. 45.58±5.04 cm), ejection fraction (63.10±3.05 vs. 65.13±2.56%), aortic root inside diameter (29.60±3.50 vs. 31.58±3.58) and pulmonary trunk (24.17±2.78 vs. 22.23±1.77) values between the test group and the control group. Besides, the test subjects had significantly longer maximum P-wave duration (123.42±12.33 vs. 108.18±9.07) and larger P-wave dispersion (47.24±13.61 vs. 28.94±9.19). In the multivariate analysis, maximum P-wave duration (OR:1.221, 95% CI:1.126-1.324) and P-wave dispersion (OR:1.164, 95% CI:1.094-1.238) were correlated with the occurrence of MS. The optimal threshold for the maximum P-wave duration and PWD were 119.50ms, and 42.50ms, respectively, and the areas under the curve were 0.859 and 0.865, respectively. Conclusions: A longer P-wave duration and a higher PWD are correlated with the increased risk of MS progression.

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Left Atrial Mechanical Functions, Atrial Electromechanical Delay and P Wave Dispersion in Patients with Mild to Moderate Psoriasis

Journal of the American College of Cardiology ◽

10.1016/j.jacc.2013.08.469 ◽

2013 ◽

Vol 62 (18) ◽

pp. C160

Author(s):

Fatma Özlem Arıcan Özlük ◽

Mustafa Yılmaz ◽

Serkan Yazıcı ◽

Tezcan Peker ◽

Dursun Topal ◽

...

Keyword(s):

Left Atrial ◽

Wave Dispersion ◽

P Wave ◽

Electromechanical Delay ◽

P Wave Dispersion ◽

Atrial Electromechanical Delay

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Assessment of atrial electromechanical delay in children with acute rheumatic fever

Cardiology in the Young ◽

10.1017/s104795111200193x ◽

2012 ◽

Vol 24 (1) ◽

pp. 27-32

Author(s):

Murat Çiftel ◽

Özlem Turan ◽

Ayşe Şimşek ◽

Fırat Kardelen ◽

Gayaz Akçurin ◽

...

Keyword(s):

Rheumatic Fever ◽

Left Atrial ◽

Acute Rheumatic Fever ◽

Wave Dispersion ◽

P Wave ◽

Electromechanical Delay ◽

P Wave Dispersion ◽

Left Atrial Enlargement ◽

Atrial Electromechanical Delay ◽

Atrial Enlargement

AbstractPurposeThere may be an increase in the risk of atrial arrhythmia due to left atrial enlargement and the influence on conduction system in acute rheumatic fever. The aim of this study is to investigate atrial electromechanical delay and P-wave dispersion in patients with acute rheumatic fever.PatientsA total of 48 patients diagnosed with acute rheumatic fever and 40 volunteers of similar age, sex, and body mass index were included in the study. The study groups were compared for M-mode echocardiographic parameters, interatrial electromechanical delay, intra-atrial electromechanical delay, and P-wave dispersion.ResultsMaximum P-wave duration, P-wave dispersion, and interatrial electromechanical delay were significantly higher in patients with acute rheumatic fever compared with the control group (p < 0.001). However, there was no difference in terms of intra-atrial electromechanical delay (p > 0.05). For patients with acute rheumatic fever, a positive correlation was identified between the left atrium diameter and the P-wave dispersion and interatrial electromechanical delay (r = 0.524 and p < 0.001, and r = 0.351 and p = 0.014, respectively). Furthermore, an important correlation was also identified between the P-wave dispersion and the interatrial electromechanical delay (r = 0.494 and p < 0.001).ConclusionThis study shows the prolongation of P-wave dispersion and interatrial electromechanical delay in acute rheumatic fever. Left atrial enlargement can be one of the underlying reasons for the increase in P-wave dispersion and interatrial electromechanical delay.

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Relationship of left atrial mechanics to electrical activity on surface electrocardiography in idiopathic dilated cardiomyopathy

Global Cardiology Science and Practice ◽

10.21542/gcsp.2019.7 ◽

2019 ◽

Vol 2019 (1) ◽

Cited By ~ 1

Author(s):

Hala Mahfouz Badran ◽

Naglaa Faheem ◽

Kerolos Wagdy Wassely ◽

Magdi Yacoub

Keyword(s):

Electrical Activity ◽

Dilated Cardiomyopathy ◽

Left Atrial ◽

P Wave ◽

Idiopathic Dilated Cardiomyopathy ◽

Electromechanical Delay ◽

Atrial Electromechanical Delay ◽

Wave Duration ◽

P Wave Duration ◽

2D Strain

Aim: (1) Assess left atrial (LA) mechanics and electromechanical delay in patients with idiopathic dilated cardiomyopathy (IDCM), and (2) examine the relationship between atrial electromechanical delay and atrial electrical activity [P-wave duration, P-wave dispersion (PWD) and P terminal force (PTF)] on surface ECG.Methods: 73 IDCM patients (age 36 ± 17 years); 63% men, 25 age & sex matched healthy subjects were studied. LA atrial electromechanical delay & mechanics (εsys, SRsys, SRe, SRa) were measured with 2D-strain. From 12-lead electrocardiograms, P-wave duration, PWD and PTF calculated.Results: Reservoir, conduit and contractile functions were predominantly reduced compared to control (P < 0:001). Intra-atrial electromechanical delay was 88.9 ± 84.6 in IDCM versus 27.4 ± 16.5 in control (P < 0:0001). In IDCM, PWD (52.89 ± 15), Pmax(98 ± 17.5) and PTF(58.2 ± 36) were significantly increased compared to control (36.20 ± 8.9, 79 ± 9.9, 25.22 ± 8.76) respectively (P < 0:0001). A positive correlation was detected between intraatrial electromechanical delay and PWD &PTF (r D 0:5, P < 0:0001). By stepwise multiple linear regression analyses, LA reservoir function (LA εsys) [β = 0:754; CI at 95%:0.3560.780, P <0:001] and LA volume [β = 0:743; CI 95%:0.4230.75, P < 0:001], and PWD [β = 0.848; CI 95%:0.311 0.644, P < 0:0001], and PTF [β = 0:927; CI 95%: 0.3570.722, P < 0:0001] are independent predictors for LA electromechanical delay in IDCM.Conclusion: In addition to altered LA mechanics, atrial electromechanical delay gets longer in IDCM and is correlated with PWD and PTF. Atrial electrical dispersion on surface ECG could be early index of LA dysfunction that deserves further study.

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